Sentinel lymph node procedure in endometrial cancer: A systematic review and proposal for standardization of future research

Beatrice Cormier; Alexandre T Rozenholc; Walter Gotlieb; Marie Plante; Christopher Giede; Communities of Practice (CoP) Group of Society of Gynecologic Oncology of Canada (GOC)

doi:10.1016/j.ygyno.2015.05.039

Sentinel lymph node procedure in endometrial cancer: A systematic review and proposal for standardization of future research

Gynecol Oncol. 2015 Aug;138(2):478-85. doi: 10.1016/j.ygyno.2015.05.039. Epub 2015 Jun 3.

Authors

Beatrice Cormier¹, Alexandre T Rozenholc², Walter Gotlieb³, Marie Plante⁴, Christopher Giede⁵; Communities of Practice (CoP) Group of Society of Gynecologic Oncology of Canada (GOC)

Affiliations

¹ Gynecologic Oncology Service, Department of Obstetrics and Gynecology, Centre Hospitalier de l'Université de Montréal, Montreal, Quebec, Canada. Electronic address: beatrice.cormier@umontreal.ca.
² Gynecologic Oncology Service, Department of Obstetrics and Gynecology, Centre Hospitalier de l'Université de Montréal, Montreal, Quebec, Canada.
³ Division of Gynecologic Oncology, Jewish General Hospital, McGill University, Montreal, Quebec, Canada.
⁴ Gynecologic Oncology Division, L'Hôtel-Dieu de Québec, Centre Hospitalier Universitaire de Québec, Laval University, Quebec City, Canada.
⁵ Department of Obstetrics, Gynecology, and Reproductive Sciences, University of Saskatoon, Saskatoon, Saskatchewan, Canada.

PMID: 26047592
DOI: 10.1016/j.ygyno.2015.05.039

Abstract

Objectives: Sentinel lymph node (SLN) procedure could be an attractive solution to the debate on lymphadenectomy in endometrial cancer; however challenges to interpreting the literature include marked heterogeneity across studies, a wide variety of injection techniques and a lack of uniformly accepted definitions for important outcomes. We aim to critically appraise the published literature and streamline terminology and methodology for future studies in this field.

Methods: We conducted a PubMed search and included all original research of endometrial cancer patients having undergone SLN procedure with an n>30. Data collected included injection technique, unilateral, bilateral, and para-aortic detection rates, and ultrastaging results. When different definitions were used for reporting outcomes, we recalculated the original study results according to our proposed definitions. Data was analyzed using descriptive statistics.

Results: Seventeen studies met our inclusion criteria. Injection sites were categorized into cervical versus corporeal. Overall detection rates ranged from 60 to 100%; studies with n>100 all had overall detection rates of >80%. Bilateral detection rates were higher with a combination of two injection agents. Para-aortic mapping was most frequent after corporeal injection techniques (39%), and was higher after deep vs. standard cervical injection (17% vs. 2%). The proportion of metastatic lymph nodes diagnosed through ultrastaging was high (around 40%) and ultrastaging of SLN upstaged approximately 5% of patients. Retrospectively applying a surgical algorithm revealed a sensitivity of 95%, a negative predictive value of 99%, and a false negative rate of 5% (with only 9 false negative cases remaining in total).

Conclusion: Results of SLN research for endometrial cancer are promising. We believe that in future studies, uniform reporting is needed to improve our understanding of the safety and feasibility of SLN in EC. We propose 2 strategies: a checklist of elements to include in future reports and the standardization of key definitions.

Keywords: Endometrial cancer; Sentinel lymph node.

Publication types

Review
Systematic Review

MeSH terms

Endometrial Neoplasms / pathology*
Female
Humans
Lymph Nodes / pathology*
Lymphatic Metastasis
Sentinel Lymph Node Biopsy / methods*
Sentinel Lymph Node Biopsy / standards*